Healthcare Provider Details

I. General information

NPI: 1700796919
Provider Name (Legal Business Name): JOSHUA KYLE CAMERINO BANTIGUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6975 NORTH AVE
LEMON GROVE CA
91945-5413
US

IV. Provider business mailing address

7689 NORCANYON WAY
SAN DIEGO CA
92126-1159
US

V. Phone/Fax

Practice location:
  • Phone: 619-589-0022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE201903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: